根据吸烟状态，饮食质量和成人哮喘症状变化的一项纵向研究
2017/11/20
摘要
曾经假设在西方国家，哮喘患病率的增加与生活方式的改变有关，包括较差的饮食。然而，我们对膳食质量和哮喘的关系所知甚少。在饮食-哮喘的关系中，需要说明BMI作为潜在的中介作用；此外，非膳食来源的氧化剂的潜在修饰作用，比如吸烟等是值得研究调查的。我们调查了膳食质量和哮喘症状变化的关系，同时评估了吸烟的修饰作用，并说明了BMI是潜在的中介。使用法国前瞻性流行病学对于哮喘的遗传和环境的研究数据，我们应用2010年健康饮食指数（AHEI-2010）评估了基线时的饮食质量以及哮喘症状的变化（稳定（作为参考），恶化，改善；平均随访时间：7年）。中介分析用来解决总的和直接的作用以及由BMI介导的间接作用。这个分析包括969个成年人（平均年龄43岁；49%男生；42%的有哮喘）。在吸烟和AHEI-2010对于哮喘症状的变化之间我们观察到了显著的相互作用（相互作用P值=0.04）。在从不吸烟的人中（n=499），关于the AHEI-2010（每十点增量）改善症状方面我们观察到了积极的总效果（多变量OR 1·39; 95 % CI 1·07, 1·80）以及积极的直接效果(OR 1·41; 95 % CI 1·09, 1·80)。我们没有观察到BMI介导的间接作用(OR 0·99; 95 % CI 0·91, 1·07)。在既往吸烟和现在吸烟的人群中，所有的效果都没有显著性意义。在从不吸烟的人群中随着时间的推移，更好的饮食质量与改善哮喘症状相关，独立于BMI。
关键词：AHEI-2010 2010年替代健康饮食指数；EGEA 关于哮喘的遗传学和环境的流行病学研究； 哮喘；BMI；饮食得分；中介分析；吸烟
Longitudinal study of diet quality and change in asthma symptoms in adults, according to smoking status.
Li Z, Kesse-Guyot E, Dumas O, Garcia-Aymerich J, Leynaert B, Pison C, Le Moual N, Romieu I, Siroux V, Camargo CA, Nadif R, Varraso R.
Abstract
It has been hypothesised that increased asthma prevalence in westernised countries is associated with changes in lifestyle factors, including a poorer diet. However, little is known regarding the association between diet quality and asthma. In the diet-asthma association, the role of BMI as a potential mediator needs clarification; moreover, potential effect modification by non-diet sources of oxidants, such as smoking, merits investigation. We investigated the association between diet quality and change in asthma symptoms, as well as assessed effect modification by smoking, while accounting for BMI as a potential mediator. Using data from the French prospective Epidemiological study on the Genetics and Environment of Asthma study, we assessed diet quality using the Alternate Healthy Eating Index 2010 (AHEI-2010) at baseline and change in asthma symptoms (stable (reference), worsening, improved; mean follow-up time: 7 years). Mediation analysis was used to disentangle total and direct effects and the indirect effect mediated by BMI. The analyses included 969 adults (mean age 43 years; 49 % men; 42 % ever asthma). We observed a significant interaction between smoking and AHEI-2010 on change in asthma symptoms (P for interaction=0·04). Among never smokers (n 499), we observed a positive total effect (multivariable OR 1·39; 95 % CI 1·07, 1·80) and a positive direct effect (OR 1·41; 95 % CI 1·09, 1·80) of the AHEI-2010 (per ten-point increment) on improved symptoms. No indirect effect mediated through BMI was observed (OR 0·99; 95 % CI 0·91, 1·07). Among former and current smokers, all effects were statistically non-significant. Better diet quality was associated with improved asthma symptoms over time in never smokers, independently of BMI.
KEYWORDS:AHEI-2010 Alternate Healthy Eating Index 2010; EGEA Epidemiological study on the Genetics and Environment of Asthma; SU.VI.MAX SUpplémentation en VItamines et Minéraux AntioXydants; Asthma; BMI; Diet scores; Mediation analysis; Smoking
曾经假设在西方国家，哮喘患病率的增加与生活方式的改变有关，包括较差的饮食。然而，我们对膳食质量和哮喘的关系所知甚少。在饮食-哮喘的关系中，需要说明BMI作为潜在的中介作用；此外，非膳食来源的氧化剂的潜在修饰作用，比如吸烟等是值得研究调查的。我们调查了膳食质量和哮喘症状变化的关系，同时评估了吸烟的修饰作用，并说明了BMI是潜在的中介。使用法国前瞻性流行病学对于哮喘的遗传和环境的研究数据，我们应用2010年健康饮食指数（AHEI-2010）评估了基线时的饮食质量以及哮喘症状的变化（稳定（作为参考），恶化，改善；平均随访时间：7年）。中介分析用来解决总的和直接的作用以及由BMI介导的间接作用。这个分析包括969个成年人（平均年龄43岁；49%男生；42%的有哮喘）。在吸烟和AHEI-2010对于哮喘症状的变化之间我们观察到了显著的相互作用（相互作用P值=0.04）。在从不吸烟的人中（n=499），关于the AHEI-2010（每十点增量）改善症状方面我们观察到了积极的总效果（多变量OR 1·39; 95 % CI 1·07, 1·80）以及积极的直接效果(OR 1·41; 95 % CI 1·09, 1·80)。我们没有观察到BMI介导的间接作用(OR 0·99; 95 % CI 0·91, 1·07)。在既往吸烟和现在吸烟的人群中，所有的效果都没有显著性意义。在从不吸烟的人群中随着时间的推移，更好的饮食质量与改善哮喘症状相关，独立于BMI。
关键词：AHEI-2010 2010年替代健康饮食指数；EGEA 关于哮喘的遗传学和环境的流行病学研究； 哮喘；BMI；饮食得分；中介分析；吸烟
（复旦大学附属中山医院呼吸内科 李蕾 摘译 杨冬 审校）
（Br J Nutr. 2017;117(4):562-571.）
（Br J Nutr. 2017;117(4):562-571.）
Longitudinal study of diet quality and change in asthma symptoms in adults, according to smoking status.
Li Z, Kesse-Guyot E, Dumas O, Garcia-Aymerich J, Leynaert B, Pison C, Le Moual N, Romieu I, Siroux V, Camargo CA, Nadif R, Varraso R.
Abstract
It has been hypothesised that increased asthma prevalence in westernised countries is associated with changes in lifestyle factors, including a poorer diet. However, little is known regarding the association between diet quality and asthma. In the diet-asthma association, the role of BMI as a potential mediator needs clarification; moreover, potential effect modification by non-diet sources of oxidants, such as smoking, merits investigation. We investigated the association between diet quality and change in asthma symptoms, as well as assessed effect modification by smoking, while accounting for BMI as a potential mediator. Using data from the French prospective Epidemiological study on the Genetics and Environment of Asthma study, we assessed diet quality using the Alternate Healthy Eating Index 2010 (AHEI-2010) at baseline and change in asthma symptoms (stable (reference), worsening, improved; mean follow-up time: 7 years). Mediation analysis was used to disentangle total and direct effects and the indirect effect mediated by BMI. The analyses included 969 adults (mean age 43 years; 49 % men; 42 % ever asthma). We observed a significant interaction between smoking and AHEI-2010 on change in asthma symptoms (P for interaction=0·04). Among never smokers (n 499), we observed a positive total effect (multivariable OR 1·39; 95 % CI 1·07, 1·80) and a positive direct effect (OR 1·41; 95 % CI 1·09, 1·80) of the AHEI-2010 (per ten-point increment) on improved symptoms. No indirect effect mediated through BMI was observed (OR 0·99; 95 % CI 0·91, 1·07). Among former and current smokers, all effects were statistically non-significant. Better diet quality was associated with improved asthma symptoms over time in never smokers, independently of BMI.
KEYWORDS:AHEI-2010 Alternate Healthy Eating Index 2010; EGEA Epidemiological study on the Genetics and Environment of Asthma; SU.VI.MAX SUpplémentation en VItamines et Minéraux AntioXydants; Asthma; BMI; Diet scores; Mediation analysis; Smoking
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对医生曾经诊断的成人哮喘患者重新评估其诊断
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U-BIOPRED研究中应用痰转录组甄别Th2和非Th2型哮喘
